Strengthening the Steering Role and Implementation of the Sectoral Policy in the Dominican Republic Mr. Juan Esteban Peguero Mateo Bureau of Health Planning and Systems, Ministry of Public Health and Social Welfare (SESPAS) Dominican Republic Ministry of Public Health and Social Welfare

Dominican Republic

General Information on the Dominican Republic Population (2007) 9,224,428 Male 49.8% Female 50.2% Area 48,442 kms 2 Population density 190 inhabitants per kms 2 Territorial division: 1 national district and 31 provinces

General Information (continued) 2007 national budget: RD$258, million SESPAS health budget: RD$17, million Equivalent to: 6.70% of the national budget 1.72% of GDP

Contents 1.Background 2.Baseline 3.Current Situation 4.Organic and Functional Challenges

1.Background State reforms (the 1980s and 1990s) in the countries of Latin America and the Caribbean Initial reform efforts: In the Dominican Republic, the reform process started in the 1990s

2. Baseline The new legal framework: Law Steering role and development of the essential public health functions (EPHF) Law Financing of the National Health System Administration of risk Delivery 2001

National health policies defined and regulations established. Regulations of the General Health Law: Regulation of the steering role and the separation of functions Commitments to the Millennium Development Goals Strategic Agenda for Health Sector Reform Preparation of the 10-Year Health Plan with broad social participation Definition of a new care model based on organization of services networks and strengthening of primary health care Legal Framework

STRENGTHENING OF SESPAS STEERING ROLE WITH AN EMPHASIS ON THE EPHF ORGANIZATION AND STRUCTURING OF PUBLIC NETWORKS OF REGIONAL-LEVEL HEALTH SERVICES PROVIDERS GUARANTEE OF EQUITABLE ACCESS TO SAFE, GOOD QUALITY, AND EFFECTIVE DRUGS. GUARANTEE OF INSURANCE, WITH AN EMPHASIS ON THE LOWER-INCOME POPULATION. Strategic Areas of Health Sector Reform

DEVELOPMENT OF HUMAN RESOURCES IN THE HEALTH SECTOR. DESIGN AND IMPLEMENTATION OF THE GENERAL INFORMATION IN HEALTH Strategic Areas of the Health Sector Reform

CONDUCT/LEAD FINANCING INSURANCEREGULATION EPHF DELIVERY OF SERVICES Economic Policy Social Direct exercise of nondelegable substantive responsibilities pertaining to the HEALTH AUTHORITY Health Authority (Citizens’ right) (Power, Governance) (Industry, Economic Interest) Exclusive functionsShared functions STEERING ROLE

It is a responsibility of the highest health authority and is the central function of the steering role. It guides the institutions of the sector and mobilizes actors and social groups in support of national health policy. It defines the capacity of the national health authority to manage strategic health plans and policies through the definition of National Health Plans and the assessment of the performance of health systems. Conduct/Lead Function

Strategic Actors Social Cabinet CNSS (National Social Security Council) CNS (National Health Council) COSENASA (National Health Insurance Council) Administrative council Service providers Steering Role SESPAS WATER SECTOR

Advances in Carrying Out the Steering Role Function

Start of the process of separating the functions of steering, insurance, delivery of services, and financing of the National Health System, as established under the new legal framework

Advance toward institutional reorganization of management of the sector and effectively exercise the steering of the National Health System, both at the central and decentralized levels, creating the: National Health Accounts Unit Sectoral Health Analysis Unit Bureau for Certification and Accreditation of Health Services

Creation of an entity to monitor and evaluate the Mobilization and Zero Tolerance campaign; follow-up and control of principal public health problems National mobilization for discussion and approval of the National Health Plan Active participation of the SESPAS in the National Health Council, National Social Security Board, and other coordination opportunities such as working and consultative groups to meet the Millennium Development Goals and other items on the national health agenda

The greatest success achieved by the National Health System of the Dominican Republic in the last three years is implementation of the Dominican Social Security System, which has benefited 2,689,115 persons, equivalent to 29% of the population. Of those, 987,115 Dominicans classified as poor correspond to the subsidized system, and 1,702,000 workers correspond to the contributory system through the implementation of family health insurance.

Challenges in the Health Sector Challenges in the Health Sector

Development of the National Health System Face new challenges Overcome the accumulated social debt and complete the unfinished agenda Protect achievement s attained

Intensify development of the regional health services network model, which is in the process of implementation through the strengthening of the organizational and managerial structure, until decentralization and functional autonomy is attained

Increase the effectiveness and impact of the National Health System, developing a comprehensive care model, with sufficient coordination between public health and care based on the primary health care and health promotion strategy Ensure adequate and sustainable financing for the subsystems, gradually increasing public spending on health up to 5% of GDP

Achieve universal coverage of the entire population with the family health insurance of the Dominican Social Security System Advance with modernization of the administrative and financial management of the SESPAS and other health sector institutions Ensure better development of human resources for health Strengthen citizen participation and the intersectoral approach in health management

Reduce the accumulated social debt, as well as social and gender inequities and inequalities in health Coordinate the health sector with processes of sustainable human development and manage it as a National Health System, through the coordinated development of its functions and subsystems according to principles and strategies established in the General Health Law (42-01) and its regulations

Intensify modernization and institution- building of the SESPAS at the central and decentralized levels (Provincial Health Bureaus, DPS) in order to effectively take on governance functions of the National Health System Relaunch and develop the primary health care strategy in order to strengthen the first level of care

Thank you very much …!!!